Gitelman syndrome associated with chondrocalcinosis and severe neuropathy: a novel heterozygous mutation in SLC12A3 gene

Reumatismo. 2020 Apr 10;72(1):67-70. doi: 10.4081/reumatismo.2020.1255.

Abstract

Gitelman syndrome (GS) is an inherited salt-wasting tubulopathy characterized by hypocalciuria, hypokalemia, hypomagnesemia and metabolic alkalosis, due to inactivating mutations in the SLC12A3 gene. Symptoms may be systemic, neurological, cardiovascular, ophthalmological or musculoskeletal. We describe a 70 year-old patient affected by recurrent arthralgias, hypoesthesia and hyposthenia in all 4 limbs and severe hypokalemia, complicated by atrial flutter. Moreover, our patient reported eating large amounts of licorice, and was treated with medium-high dosages of furosemide, thus making diagnosis very challenging. Genetic analysis demonstrated a novel heterozygous mutation in the SLC12A3 gene; therefore, we diagnosed GS and started potassium and magnesium replacement. GS combined with chondrocalcinosis and neurological involvement is quite common, but this is the first case of an EMG-proven severe neuropathy associated with GS. Herein, we underline the close correlation between hypomagnesemia, chondrocalcinosis and neurological involvement. Moreover, we report a new heterozygous mutation in exon 23 (2738G>A), supporting evidence of a large genetic heterogeneity in this late-onset congenital tubulopathy.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Chondrocalcinosis / complications*
  • Electromyography
  • Furosemide / administration & dosage
  • Gitelman Syndrome / complications*
  • Gitelman Syndrome / diagnosis
  • Gitelman Syndrome / genetics
  • Glycyrrhiza / adverse effects
  • Humans
  • Hypercalciuria / complications
  • Male
  • Nephrocalcinosis / complications
  • Nervous System Diseases / complications*
  • Nervous System Diseases / diagnosis
  • Renal Tubular Transport, Inborn Errors / complications
  • Sodium Potassium Chloride Symporter Inhibitors / administration & dosage
  • Solute Carrier Family 12, Member 3 / genetics*

Substances

  • Sodium Potassium Chloride Symporter Inhibitors
  • Solute Carrier Family 12, Member 3
  • Furosemide

Supplementary concepts

  • Hypomagnesemia primary